Lumbar Disc Disease (Herniated Disc)

Anatomy of the lumbar spine:

The vertebral column, also called the backbone, is made up of 33 vertebrae that are separated by spongy disks and classified into four distinct areas. The cervical area consists of seven bony parts in the neck; the thoracic spine consists of 12 bony parts in the back area; the lumbar spine consists of five bony segments in the lower back area; five sacral bones (fused into one bone, the sacrum); and four coccygeal bones (fused into one bone, the coccyx).

Lumbar disc disease occurs in the lumbar area of the spine. The lumbar area of the spine (and other areas of the spine) is made up of two parts, including the following:

• vertebral bodies – the parts that are made of bone.
• intervertebral discs – also known as the discs; the discs are located between the bony parts of the spine and act as “shock absorbers” for the spine.

The vertebral bodies are numbered from 1 to 5 in the lumbar spine and the discs are located between two of the vertebral bodies and are numbered accordingly (such as a disc at L2-3, or between the lumbar discs numbered 2 and 3).

The intervertebral disc is composed of two parts, including the following:

• annulus fibrosis – a tough outer ring of fibrous tissue.
• nucleus pulposus – located inside the annulus fibrosis; a more gelatinous or soft material.

What causes lumbar disc disease?

Lumbar disc disease is due to a change in the structure of the normal disc. Most of the time, disc disease comes as a result of aging and the degeneration that occurs within the disc. Occasionally, severe trauma can cause a normal disc to herniate. Trauma may also cause an already herniated disc to worsen.

Treatment for lumbar disc disease:

Specific treatment for lumbar disc disease will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• type of condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Typically, conservative therapy is the first line of treatment to manage lumbar disc disease. This may include a combination of the following:

• bed rest
• patient education on proper body mechanics (to help decrease the chance of worsening pain or damage to the disc)
• physical therapy, which may include ultrasound, massage, conditioning, and exercise programs
• weight control
• use of a lumbosacral back support
• medications (to control pain and/or to relax muscles)

When these conservative measures fail, surgery for removal of a herniated disc may be recommended. Surgery is done under general anesthesia. An incision is placed in the lower back over the area where the disc is herniated. Some bone from the back of the spine may be removed to gain access to the area where the disc is located. Typically, the herniated part of the disc and any extra loose pieces of disc are removed from the disc space.

After surgery, restrictions may be placed on the patient’s activities for several weeks while healing is taking place to prevent another disc herniation from occurring. Your physician will discuss any restrictions with you.

There are other experimental therapies that are being used to treat lumbar disc disease. Discuss these treatment options with your physician.